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adolescents with SEN. This study had ethical approval from the
Multicentre Research Ethics Committee for Scotland. It involved
head teachers of 99 schools around Scotland identifying pupils
aged 13–22 years whom they would estimate as functioning in
the borderline to mild intellectual disability range (estimated IQ
between 50–80) and were therefore receiving special educational
assistance.
Adolescents with SEN were assessed with the Clinical
Interview Schedule (CIS) to evaluate the presence of psychiatric
symptoms. A total of 247 individuals with SEN were recruited
to the study. They completed the CIS at baseline (T1), 1–2
years later (T2) and 6 years later (T3). At T3, the participants
also completed the World Health Organisation Disability
Assessment Schedule 2.0 (WHO-DAS) to measure the degree of
functional impairment. Correlation statistical analyses were car-
ried out to find whether there was a significant relationship
between CIS and total WHO-DAS scores.
Results. There was a statistically significant correlation between
total WHO-DAS score with slowness and anxiety symptoms
(p values 0.008 and 0.024 respectively) measured on the CIS at
T1. None of the symptoms measured on CIS at T2 had a statistic-
ally significant correlation with total WHO-DAS score. With the
symptoms that were significant, after application of a Bonferroni
correction, none of the symptoms measured on CIS had a statis-
tically significant correlation at any time point with total
WHO-DAS score.
Conclusion. Our results show that there is some evidence that
anxiety and slowness in adolescence are associated with greater
functional impairment in young adulthood. However, further
research is required to confirm this relationship. Our data high-
light the potential value of identification and treatment of psychi-
atric symptoms in early adolescence.
The Effect of the COVID-19 Pandemic on Young
People With OCD
Dr Sharna Bennett*
North East London NHS Foundation Trust, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.175
Aims. The full impact of the ongoing COVID-19 pandemic is yet
to be determined, but it is likely to have had a significant influ-
ence on the development of young people, especially those with
mental health conditions such as Obsessive Compulsive
Disorder (OCD). This study aims to investigate the change in
symptoms and whether these were linked to COVID-19/lock-
down, as well as the treatment and support received.
Methods. The Mood and Anxiety team for West Kent were con-
tacted to request patients with a diagnosis of OCD. A total of 16
patients were included (12–18 years, 63% female), as they were
known to services prior to March 2020. Data were retrospectively
collected by searching electronic notes between September 2018
and October 2021 to identify patient demographics, OCD symp-
toms and severity (and whether this had been affected by
COVID-19/lockdown), and if they were receiving medication
and therapy. It was noted whether questionnaires had been
completed, and how frequently patients were contacted by
CAMHS.
Results. 75% of young people reported increasing OCD symp-
toms after March 2020. Of the patients who reported an increase
in symptoms, nearly half (47%) explicitly attributed this to either
the COVID-19 pandemic or lockdown. Prior to March 2020, 31%
of patients were receiving medication for OCD, this increased to
69% of patients between March 2020 and September 2021. 31% of
patients were undergoing therapy for OCD prior to March 2020,
and over the following 18 months, 50% were receiving therapy,
with the remainder of patients on the waiting list. The most com-
mon therapy was CBT. Prior to March 2020, 13% of patients had
completed questionnaires relevant to OCD, which increased to
44% between March 2020-Septermber 2021. Patients were con-
tacted more frequently via CAMHS post-March 2020 (62.5% vs
25%), but the method of contact switched to mainly remote
methods.
Conclusion. Overall, there was an increase in OCD symptoms dur-
ing the pandemic, with a proportion of patients identifying either
COVID-19 or lockdown as contributing factors. The number of
patients receiving both psychological and pharmacological therapy
for OCD increased. There were low numbers of patients complet-
ing questionnaires for OCD, which would be a useful way to iden-
tify changes in symptoms across patients. Contact from mental
health services increased during the pandemic, although this
shifted to virtual formats. This suggests that CAMHS need to pre-
pare for the possible increasing need for services due to the pan-
demic and provide support targeted to those with OCD.
Gender Identity and Questioning in Klinefelter’s
Syndrome
Ms Valerie Cai1* and Mr Tet Yap2
1
King’s College London, London, United Kingdom and
2
Guy’s and
St Thomas’NHS Foundation Trust, London, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.176
Aims. KS is a congenital condition with 47, XXY chromosome
karyotype. Due to a lack of understanding of the condition
amongst healthcare providers, KS is grossly underdiagnosed,
with most patients never receiving a diagnosis. Within this popu-
lation, gender dysphoria is suggested to be of higher incidence
than in the general population. To establish the validity of this
claim and to improve care for patients with KS, particularly in
the area of gender service provision, we need to identify whether
there is a significant proportion of XXY individuals that experi-
ence gender dysphoria. The aim of our study is to determine
whether UK patients with a diagnosis of KS are more predisposed
to gender dissatisfaction.
Methods. A PRISMA literature review was conducted on the epi-
demiology, management, and treatment outcomes of KS patients
with gender dysphoria. Based on the results of the literature
review, we then conducted a cross-sectional survey of patients ser-
viced by the Klinefelter Syndrome Association on gender satisfac-
tion. The survey recorded 81 responses.
Results. Of the entire study population, gender distribution was
65% male, 6% female, 4% non-binary, 2% gender fluid, 3% nei-
ther, 1% equally male and female, and 1% intersex. This con-
trasted with most patients’assigned birth on their birth
certificate, which was 92.5% male and 3.75% female. Most
patients surveyed enjoyed living as the sex written on their
birth certificate (61.64%), which seemed to correlate closely
with the proportion of patients that identified as male (65%).
Conclusion. Literature Review: As a whole, KS patients documen-
ted in research presented to psychiatric and sexual health services
during adulthood, requesting either sex reassignment surgery or
changes to hormonal replacement therapy. The sparse amount
of research over a long period of time has created a reliance on
outdated research techniques. Patient Survey: Survey results
show that there are a significant proportion of survey respondents
S44 Poster Presentations
https://doi.org/10.1192/bjo.2022.176 Published online by Cambridge University Press
that do not identify as male despite it being written on their birth
certificate; however, the majority prefer to be identified as male.
This suggests that certain individuals with KS are at higher risk
of gender dissatisfaction and dysphoria. Importantly, these obser-
vations are not substantiated with clinical judgement of a psych-
iatrist/mental health worker, which should aim to be incorporated
in future research. Additionally, longitudinal studies should aim
to establish whether certain age groups would be more at risk
of gender dissatisfaction and gender dysphoria or if trends change
with age.
A Pilot Study of Service Utilisation Pathways of
Patients With Distinct Psychotic and Antisocial
Typologies
Dr Alexander Challinor1,2,3*, Dr Neil Meggison3,4,
Dr Jonathon Whyler5,3, Dr Phoebe Cresswell4, Dr Leah Evans4,
Dr Michael Bingley4, Dr Praveen Somarathne4,
Ms Jodi Thompson4, Dr Dawn Washington4
and Professor Taj Nathan5,6,2,7
1
Mersey Care NHS Foundation Trust, Liverpool, United Kingdom.;
2
University of Liverpool, Liverpool, United Kingdom;
3
Health
Education North West, Manchester, United Kingdom;
4
Lancashire
and South Cumbria NHS Foundation Trust, Lancashire, United
Kingdom;
5
Cheshire and Wirral Partnership NHS Trust, Chester,
United Kingdom;
6
University of Chester, Chester, United Kingdom
and
7
Liverpool John Moores University, Liverpool, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.177
Aims. There is a developing body of research that suggests that
there may be distinct categories of patients that can explain the rela-
tionship between psychosis and antisocial behaviours. Specifically,
three pathways of offending, antisocial behaviour and psychosis
have been described and there is an evolving empirical evidence
base to suggest that these pathways are aetiologically distinct.
Firstly, there is a pathway for early-start offenders, which have
been identified as those with psychosis preceded by Conduct
Disorder (SZ + CD). Secondly, a group that start to display anti-
social behaviours in parallel to the onset of psychosis (SZ-AS).
The third group involves those with a long history of a psychotic
disorder and no history of antisocial behaviours, who will present
to services following a first conviction for non-violent or violent
crime (SZ). The authors hypothesise that each typology will
utilise services differently throughout the clinical trajectory. This
pilot study aimed to (i) examine the concurrent validity of the anti-
social behaviour and psychosis typologies, and (ii) examine differ-
ences in the service utilisation patterns of patients between these
groups.
Methods. The sample consisted of adult male patients admitted
to low and medium secure forensic hospitals within the
Northwest of England. A total of 90 patients were used.
A categorisation checklist was developed, and the typology of
patients determined from data collected from electronic health
records. Data were collected on patient demographics, psychiatric
diagnosis, aetiological factors, and service utilisation. Two
researchers reviewed the data and determined the typology.
Statistical analysis aimed to assess the difference in aetiological
variables between the typologies and examine the relationship
with how each typology utilised services.
Results. This study provided further evidence of distinguishing
characteristics emphasising typology heterogeneity.
The CD-SZ group were more likely to have utilised mental
health services <18 years (70%, p = 0.062), and to have used
services preceding a diagnosis of psychosis (60%, p = 0.011).
Following the onset of a psychotic disorder, the AS-SZ and SZ
groups had a higher proportion that used general adult psychiatry
services (p = 0.031), with CD-SZ coming in to contact with foren-
sic psychiatry services and criminal justice services earlier and
more frequently.
Conclusion. This study demonstrates that each typology has a
different clinical trajectory through mental health services. This
provides further empirical evidence towards different clinical typ-
ologies and trajectories of individuals with psychosis and anti-
social behaviour. Understanding more about how these typologies
utilise services will enable clinicians to introduce interventions
help develop effective management plans that address the distinct
characteristics of each typology of offender with psychosis.
Theory of Mind Deficits in Bipolar Disorder in
Remission
Dr Shravani Chauhan*
Roseberry Park Hospital, Middlesbrough, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.178
Aims. Theory of mind (ToM) is the ability to represent one’sown
and other’s mental state. Studies in bipolar affective disorder show
mixed results possible due to confounding factors like intelli-
gence, attention, phase of illness and current mood. Purpose of
this study is to study ToM in remittent bipolar disorder patients
and compare with normal controls to find if there are residual
deficits during remission
Methods. 40 bipolar patients in remission and 40 age and sex
matched controls were recruited. Clinical remission for 3 months
with YMRS <4 and HAM-D <7 was inclusion criteria. ToM was
assessed by Faux Pas test. Data were analysed using SPSS-11.5 for
Windows with parametric and non-parametric tests as indicated.
Level of significance taken as p < 0.05 (two tailed).
Results. Mean age of onset of illness in patient group was 23.8
years with duration of illness 11.3 years. Mean number of epi-
sodes 6.7 and duration of remission 4.15 months. ToM test result
revealed deficit in recognizing social cues in faux pas test by bipo-
lar patients as compared to normal controls. There was no differ-
ence between both groups in test result on control stories.
Conclusion. Results suggest that ToM deficits are present in bipo-
lar disorder patients even during apparent clinical remission, indi-
cating it may be a trait marker of the illness. There is no deficit in
understanding a regular social context without faux pas. It also
revealed that there is no correlation with ToM and duration of
illness
The Prevalence of Autism in the Criminal Justice
System: A Systematic Review
Ms Verity Chester1,2*, Dr Karen Bunning1,
Dr Samuel Tromans3,4, Professor Regi Alexander2,5
and Professor Peter Langdon6
1
University of East Anglia, Norwich, United Kingdom;
2
Hertfordshire
Partnership University NHS Foundation Trust, Norwich, United
Kingdom;
3
University of Leicester, Leicester, United Kingdom;
4
Leicestershire Partnership NHS Trust, Leicester, United Kingdom;
5
University of Hertfordshire, Hatfield, United Kingdom and
6
University of Warwickshire, Coventry, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.179
BJPsych Open S45
https://doi.org/10.1192/bjo.2022.176 Published online by Cambridge University Press
